Bill Gates expresses confidence that we’ll have a COVID-19 vaccine in 18 months. If you drill down you’ll find a little more wiggle room, but even so, this is Gates’ trademark optimism ratcheted up to a high level: he’s calling out the coronavirus for a cage match. It’s a bold position, given that most attempts to create vaccines fail, and even the successful ones take a long time–10 years or more. There’s never been a human vaccine created in less than about 5 years, according to Gates, yet he’s confident we’ll have one this time in less than two years, and as soon as 9 months! What’s that optimism based on? Here’s a summary of Bill Gates’ reasons for believing we can achieve a safe, effective vaccine that’s deployable in less than two years:
- Parallel development. The normal pathway for vaccine development is sequential, but doesn’t have to be. Gates argues that the biggest reason for developing vaccines step-by-step is financial—why waste money testing for efficacy before you even know if the vaccine is safe? In this case, he argues, financial constraints don’t apply, so it will be possible to considerably overlap the phases. In the world he comes from, the speed benefits of parallel processing are considerable, so why not here too?
- Flood the zone. Most of the time, only a handful of possible vaccines for a given disease are being developed at the same time. Again, this is for economic reasons. The vaccine business isn’t the most compelling business big pharma pursues, so its denizens are quick to avoid joining a crowded competition and risking splitting the market. Since financial prudence is irrelevant here as well, there are over 100 vaccine projects underway, which seems likely to improve the odds that at least a few will clear the high hurdles, of safety, efficacy, and scalability. Moreover, the projects are diverse, rather than 100 efforts to do exactly the same thing.
- Pre-built factories. Usually a facility to manufacture a vaccine on a large scale isn’t built until late in the process, because each is unique and nobody wants to waste money before knowing they’ve got a winning product. Again, that’s not an issue this time. The Gates Foundation and other organizations are pre-building factories for a number of different vaccine types, and will throw away the billions of dollars spent to build the ones not needed.
- Better scientific and technical starting-points. Scientific and technical advances make it easier to go faster now than was the case during earlier generations of vaccine development. Not only have there been advances in the life sciences (which made it possible to sequence the vaccine’s genome in a matter of weeks), but advances in information technology speed up analysis and collaboration. Also, luckily, a lot of work was done a few years ago on a SARS vaccine, which gives some efforts a head start today.
- Imperfection is acceptable. A perfect vaccine would be ideal, but a vaccine can be considerably less that perfect and still make a big difference. The smallpox vaccine was not entirely safe and was unpleasant to receive, but was good enough to eradicate smallpox entirely. Gates estimates that a vaccine that is effective 70% of the time and confers immunity for one season (assuming this virus is seasonal) would still make a big difference—approximate herd immunity—while work continues on a perfect vaccine. This year’s flu vaccine, for example, is about 45% effective, and lasts about 3 months, yet was worth having.
And why should we give credence to Gates’ optimism about creating a vaccine?
- He knows his stuff. Gates has had an interest in the life sciences going back decades, and when he gets interested in something, he goes deep. The Gates Foundation has, from the beginning, focused on infectious diseases. Gates was issuing public warnings about the risk of a global respiratory pandemic five years ago. The Gates Foundation is deeply invested in vaccines. He’s not new to this subject matter; his views today are based on years of thought and learning.
- He’s in a position to change the game. The Gates Foundation was the world’s largest funder of vaccines before SARS CoV-2 came along. He and Melinda are concentrating the resources of the Foundation on this challenge to an extent unlike anything they’ve ever done before. He knows he’s in a position to accelerate multiple efforts and break logjams.
- He’s the right size. Gates changed the world in his 20s by ushering in the age of personal computing. He made Microsoft the world’s most valuable company, himself the world’s wealthiest individual, and the Gates Foundation the world’s second-largest (by assets) foundation. He believes “Humankind has never had a more urgent task than creating broad immunity for coronavirus.” Step right up, sir.
- We simply have to. Gates understands better than most the epic scale of this vaccine’s challenge: in the face of its magnitude, he believes the will and resources to achieve near miracles will be available. Just as WWII saw us bring forth radar, code-breaking, reliable torpedoes, nuclear power, and the ability to build bombers and destroyers in days rather than months, the pandemic will see us bring forth vaccines in record time.
- Optimism is effective. Heroic efforts are more likely to succeed if leaders express unwavering belief that they will succeed. Bill Gates is an optimist because the explicit optimism of a credible leader is an effective tool, and he believes that effectiveness is almost a moral obligation.
There are plenty of smart, expert people who are less optimistic than Bill Gates. Many veterans of virus wars, wearier and warier, expect a longer, harder slog–5 or 10 years, perhaps. Many have broken their lances against pathogens less challenging than this, and go into battle braced for a marathon. Gates freely admits that he’s an optimist by nature, and at times he’s had to work to rein it in. This is not one of these times. This is the challenge of a lifetime for a supremely capable, incredibly competitive man. He’s not going to miss this fight for anything, and he likes his chances. No matter how skeptical you might be, you have to hope he’s right, and be glad he’s all-in.
If you’d like to dig deeper on Bill Gates’ views about the COVID-19 pandemic and the prospects for a vaccine, I recommend you read his articles about the virus on Gates Notes, his blog.
Here he is talking about these issues in conversation with Vox’s Ezra Klein.
I just heard from epidemic warrior Fred Brown, who adds two more important positive factors: regulatory agencies around the world are set up to streamline the approval process as much as they safely can, and the degree of collaboration and information-sharing between scientists around the world is unprecedented–their commitment to finding a solution transcends their loyalties to their companies and their countries. Bill Gates has discussed these factors as well and I should have included them. For more about Fred Brown and his work, see my recent Post Alley article:
What other Seattle resources will help in this effort? Certainly the Hutch. Children’s? And which parts of U.W.? Leroy Hood? It’s thrilling to have so much of this taking place under our noses in Seattle. All our earlier investments in biological sciences and global health are proving out.
All of the above… plus the Institute for Health Metrics and Evaluation, the Brotman Baty Institute, the Infectious Disease Research Institute… I’d love to see a complete list, it would be long!
Another way time can be saved by modifying testing protocols. As I understand usually testing is done in two sequential stages. First safety with a small cohort, then efficacy with a large enough cohort to get meaningful statistics. But in the case of Covid-19 perhaps it would be ethical to go straight to the larger cohort. If I worked in a meat-processing facility I’d probably be willing to risk it.
Actually 3 Phases: I is safety, II is efficacy on a small scale, and III is safety and efficacy on a larger scale “in the wild.” If you follow the link in the article, you can see how Gates proposes to stack those stages against each other and the manufacturing ramp-up and regulatory cycle.
Encouraging and convincing, Tom!